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December 15, 1978

Digoxin Therapy During T-Tube Biliary Drainage in Man

Author Affiliations

From the Departments of Medicine and Pharmacology, University of Kansas Medical Center, College of Health Sciences and Hospital, Kansas City.

JAMA. 1978;240(25):2756-2757. doi:10.1001/jama.1978.03290250060032

BILIARY excretion and enterohepatic recirculation of digitoxin has been demonstrated in man.1 Recently it has been recognized that digoxin may also undergo biliary elimination and enterohepatic recycling.2,3 We report the consequence of biliary excretion of digoxin in a patient subjected to bile drainage after cholecystectomy.

Report of a Case  An 82-year-old man weighing 59 kg was taking digoxin, 0.125 mg/day; 1-thyroxine, 0.2 mg/day; and furosemide, 40 mg/day. He was jaundiced and dyspneic. Moist rales at both lung bases and gallop rhythm were present. The right upper quadrant was tender to deep palpation. Sonography demonstrated a distended gallbladder with numerous small calculi. Blood cell counts showed leukocytosis with an increased number of polymorphonuclear leukocytes. There was a threefold elevation of the normal serum bilirubin and alkaline phosphatase levels; BUN levels ranged from 29 to 48 mg/dl, and serum creatinine levels ranged from 1.3 to 2.0 mg/dl. Creatinine clearance calculated